Key result
Increased aortic angulation (>48°) did not significantly affect TAVI device success (77.2% vs 81.2%, p=0.582) but was associated with higher rates of paravalvular aortic regurgitation.
Why the study?
The effect of aortic angulation on procedural and short-term outcomes with the self-expanding Portico valve for TAVI has not been fully investigated.
Does increased aortic angulation (>48°) reduce device success or worsen early outcomes in patients undergoing TAVI with a self-expanding Portico valve?
Observational (n=121)
No
Does increased aortic angulation (>48°) reduce device success or worsen early outcomes in patients undergoing TAVI with a self-expanding Portico valve?
While aortic angulation >48° does not significantly reduce 30-day device success with the self-expanding Portico valve, it is associated with increased procedural complexity, valve malposition, and paravalvular regurgitation.
Aortic angulation >48° may raise paravalvular regurgitation risk with Portico TAVI; leaves open whether angulation should guide valve selection.
Introduction: Aortic angulation (AA), defined as the angle between the aortic annulus plane and the horizontal plane, may result in failed prosthesis positioning. The effect of AA on the procedural and short-term outcomes with the portico valves for transcatheter aortic valve implantation (TAVI) has not been fully investigated. The present study aimed to evaluate the impact of AA on device success and early outcomes of TAVI using a selfexpanding portico valve. Patients and Methods: Preoperative computed tomography scans of 121 consecutive patients treated with the portico valve were analyzed. TAVI device success and outcomes were determined according to VARC-3 definitions. Patients were divided into two groups based on mean AA. Results: The mean AA was 48.7 ± 8.9°. There were no differences in technical success (92.2 vs 89.5%, p= 0.604), device success (81.2% vs 77.2%, p= 0.582), and early safety endpoints (68.8% vs 61.4%, p= 0.397) between the AA≤ 48° and AA>48° groups. The frequency and severity of paravalvular aortic regurgitation (PAR) was statistically higher in patients with AA> 48° (p= 0.028). Moreover, an increased AA was also associated with valve malposition (12.3% vs. 1.6%, p= 0.018), prolonged procedure time (85 ± 26 vs. 75 ± 20 minutes, p= 0.028), and greater Δimplantation depth (2.2 ± 0.5 vs. 0.8 ± 0.1 mm; p<0.001). Conclusion: Despite comparable device success and early outcomes rates, increased AA is associated with higher rates of PAR and valve malposition, with the self-expanding portico valve.
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Aslan et al. (2022) conducted an observational in Severe aortic stenosis (n=121). TAVI in patients with high aortic angulation (>48°) vs. TAVI in patients with low aortic angulation (≤48°) was evaluated on Device success at 30 days (VARC-3 definition) (p=0.582). Increased aortic angulation (>48°) did not significantly affect TAVI device success (77.2% vs 81.2%, p=0.582) but was associated with higher rates of paravalvular aortic regurgitation.
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